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Comparison Influence to Prognosis of CTP and MRP in AIS Patients

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ClinicalTrials.gov Identifier: NCT03367286
Recruitment Status : Recruiting
First Posted : December 8, 2017
Last Update Posted : December 8, 2017
Sponsor:
Information provided by (Responsible Party):
Second Affiliated Hospital, School of Medicine, Zhejiang University

Brief Summary:

Acute ischemia stroke (AIS) is the leading cause of death in China. Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) has been proven to reduce disability in AIS patients within 4.5 hours after symptom onset. However, only 2% of AIS patients received thrombolytic therapy in China.

Perfusion imaging is demonstrated to increase the rate of thrombolytic therapy by identifying the ischemic infarct core (the brain tissue that is irreversibly injured) and the ischemia penumbra (the brain tissue surrounding the ischemia infarct core that is hypoperfused but still viable) for those patients with extending therapeutic window (beyond the current 4.5 hours after symptom onset), as well as minor stroke or those with atypical symptoms.

Three prospective clinical trials, DEFUSE, DEFUSE-2 and EPITHET, has confirmed that mismatch between perfusion weighted-imaging (PWI) and diffusion weighted-imaging (DWI) correspond to the ischemic penumbra whereas DWI provides information of the ischemia infarct core and major reperfusion relate to good clinical outcome in extending therapeutic window AIS patients with DWI-PWI mismatch.

Computed tomography perfusion (CTP) may be a potential alternative technology for recognition of reversibly damaged brain tissue in AIS patients, with the prominent advantage of fast scan. Recent studies also demonstrated that CTP could select eligible candidates for reperfusion therapy. More recently, with data of EXTEND-IA, reperfusion therapy in AIS patients with CTP mismatch (using a CT time to maximum >6 s as ischemic hypoperfusion volume and a CT relative cerebral blood flow <30% of that in normal tissue as ischemic core volume) were related to good clinical outcome.

However, plenty of studies demonstrated CT cerebral blood volume did not always predict ischemic infarct core in AIS patients. A recent study also confirmed the poor contrast: noise ratios of CT cerebral blood volume and CT cerebral blood flow result in large measurement error, compared with those of diffusion weighted imaging (DWI), making it problematic to substitute DWI in selecting individual AIS patients for reperfusion treatment.

Based on those studies, it is still remained unclear whether CTP can be an alternative choice to replace magnetic resonance perfusion (MRP) in AIS patients with extending therapeutic windows. So in this study, the investigators try to determine whether baseline CTP profiles have a comparable ability to MRP in identifying patients who have a robust clinical response after early reperfusion.


Condition or disease Intervention/treatment
Stroke Other: inspection mode

Detailed Description:

This is a prospective, non-blind, single-center clinical trial to evaluate whether baseline computed tomography perfusion (CTP) profiles have a comparable ability to magnetic resonance perfusion (MRP) in identifying acute ischemia stroke (AIS) patients who have a robust clinical response after early reperfusion.

The study will enroll 1000 patients, and patients will be divided into 2 groups according to the imaging available situation (to see which can provide immediately): CTP scan group and MRP scan group.

Core: CT: cerebral blood flow <30% of that in normal tissue / MR: ADC < 600 ×D10-6 mm2 / s.

Hypoperfusion: CT / MR: time to maximum >6.

For patients accepting CTP or MRP over 4.5 hours after stroke onset, only patients who meet imaging criteria (infarct core volume < 70mL, perfusion lesion volume / infarct core volume >1.2, and absolute mismatch >10 mL) at baseline will receive recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis. CTP or MRP will be performed at 24 hours after thrombolytic therapy. Modified Rankin score (mRS) will be measured at 3 months after stroke onset.

Study Endpoints: Primary endpoint: mRS 0-2 at 3 months. Secondary endpoints: (1) symptomatic intracranial haemorrhage, (2) reperfusion, (3) recanalization, and (4) infarct growth at 24 hours.

Criteria:

Inclusion Criteria:

  1. Provision of informed consent;
  2. Male and female adults aged 18-80 years old;
  3. For patients accepting CTP or MRP over 4.5 hours after stroke onset, imaging criteria: infarct core volume <70mL, perfusion leison volume / infarct core volume >1.2, and absolute mismatch >10 mL.

Exclusion Criteria:

  1. Standard contraindications to rt-PA;
  2. Contraindication to imaging with contrast agents;
  3. Pre-stroke mRS score of ≥2 (indicating previous disability);
  4. Participation in any investigational study in the previous 30 days;
  5. Any terminal illness such that patient would not be expected to survive more than one-year.

Study Type : Observational
Estimated Enrollment : 1000 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Comparison Influence to Prognosis of Computed Tomography Perfusion (CTP) and Magnetic Resonance Perfusion (MRP) in Acute Ischemic Stroke (AIS) Patients
Actual Study Start Date : June 30, 2009
Estimated Primary Completion Date : June 30, 2020
Estimated Study Completion Date : December 30, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: CT Scans

Group/Cohort Intervention/treatment
Computed Tomography Perfusion (CTP) Other: inspection mode
different inspection modes:Computed Tomography Perfusion (CTP) or Magnetic Resonance Perfusion (MRP)

Magnetic Resonance Perfusion (MRP) Other: inspection mode
different inspection modes:Computed Tomography Perfusion (CTP) or Magnetic Resonance Perfusion (MRP)




Primary Outcome Measures :
  1. modified Rankin Scale at 90 days [ Time Frame: 90 days ]
    modified Rankin Scale at 90 days



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
acute ischemic stroke patients
Criteria

Criteria:

Inclusion Criteria:

  1. Provision of informed consent;
  2. Male and female adults aged 18-80 years old;
  3. For patients accepting CTP or MRP over 4.5 hours after stroke onset, imaging criteria: infarct core volume <70mL, perfusion leison volume / infarct core volume >1.2, and absolute mismatch >10 mL.

Exclusion Criteria:

  1. Standard contraindications to rt-PA;
  2. Contraindication to imaging with contrast agents;
  3. Pre-stroke mRS score of ≥2 (indicating previous disability);
  4. Participation in any investigational study in the previous 30 days;
  5. Any terminal illness such that patient would not be expected to survive more than one-year.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03367286


Contacts
Contact: Min Lou, Ph.D 13958007213 loumingxc@vip.sina.com

Locations
China
The second affiliated hospital of Zhejiang University Recruiting
Hangzhou, China, 310000
Contact: Min Lou, Ph.D    13958007213    loumingxc@vip.sina.com   
Sponsors and Collaborators
Second Affiliated Hospital, School of Medicine, Zhejiang University

Responsible Party: Second Affiliated Hospital, School of Medicine, Zhejiang University
ClinicalTrials.gov Identifier: NCT03367286     History of Changes
Other Study ID Numbers: CIPPIS
First Posted: December 8, 2017    Key Record Dates
Last Update Posted: December 8, 2017
Last Verified: September 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Stroke
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases